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Dijksma I, Stuiver M, Lucas C, Lindeboom R. Evaluating the psychometric properties of the Grit scale in Marine recruits using Rasch analysis. BMJ Mil Health 2023; 169:425-429. [PMID: 34615729 PMCID: PMC10579500 DOI: 10.1136/bmjmilitary-2021-001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Successful completion of initial military training has been suggested to be predicted by physical abilities, cognitive abilities and non-cognitive abilities such as hardiness and grit. This study aimed to assess the psychometric properties of a Dutch version of a grit measurement scale: the NL-Grit scale. METHODS We assessed the factor structure, unidimensionality of the subscales, discriminative quality of the rating scale and investigated to what extend the items together can reliably measure the entire range of grit levels in Dutch Marine recruits. We used data of Marine recruit training platoons of the Royal Netherlands Marine Corps. RESULTS Principal component analysis reflected two subscales: 'consistency of interests' and 'perseverance of effort'. Rasch analysis confirmed the unidimensionality of the intended subscales. Rasch rating scale analysis indicated that the five-point response scale was not used as intended by respondents. Disordered rating scale categories were collapsed to obtain ordered rating categories. The item and person parameters (grit levels) largely overlapped, indicating that the item spread was sufficient for measuring the entire range of grit trait levels. However, larger gaps between item location parameters suggested a low discriminative capacity of the NL-Grit scale for respondents with trait levels within the gaps. CONCLUSION Our evaluation of the NL-Grit scale suggests sound psychometric quality of the NL-Grit in Dutch Marine recruits. Reliability could be improved by adding items to fill the observed gaps in item content.
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Affiliation(s)
- Iris Dijksma
- Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Defense Health Care Organization, Royal Netherlands Army, Utrecht, The Netherlands
| | - M Stuiver
- Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - C Lucas
- Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - R Lindeboom
- Epidemiology and Data Science, Master Evidence Based Practice in Health Care, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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Van Trier T, Jorstad HT, Snaterse M, Scholte Op Reimer WJM, Visseren FLJ, Dorresteijn JAN, Wareham NJ, Lindeboom R, Peters RJG, Boekholdt SM. Cardiovascular mortality risk beyond 10 years in men and women; long-term follow-up from the EPIC-Norfolk prospective population study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Current primary prevention strategies in cardiovascular (CV) disease focus on initiating preventive interventions in people at high 10-year risk of CV mortality. However, initiating such strategies should be beneficial not only in the first 10 years, but throughout life. Established risk algorithms estimate the risk of 10-year CV mortality, but limited evidence is available about the relationship between 10-year and longer-term CV mortality.
Purpose
To compare cumulative incidence of CV mortality in a population cohort at 10- and 20-years follow-up, stratified by sex.
Methods
We analysed CV mortality at 10-years and 20-years follow-up using Kaplan-Meier estimates among men and women aged 39–70 years without baseline CV disease or diabetes mellitus in the large, prospective population-based EPIC-Norfolk cohort. CV mortality included death with as underlying or contributing cause ischaemic heart disease, heart failure, cerebrovascular disease or peripheral artery disease.
Results
We analysed data from 20,453 participants (56% women), with a mean age of 56±8 years, and median (IQR) follow-up of 22 (21–23) years. At baseline, there were no clinically relevant differences in CV risk factors between men and women. Overall cumulative CV mortality rate was 1.9% (384 deaths) in the first 10 years, and 7.3% (995 deaths) at 20 years follow-up (ratio 3.8). Among men, 10-year CV mortality was 2.9% (249 deaths), and 9.6% (785 deaths) at 20 years follow-up (ratio 3.3). Among women, CV mortality was 1.2% (135 deaths) at 10 year and 5.5% (594 deaths) at 20 years follow-up (ratio 4.6).
Conclusion
We observed an incremental increase in CV mortality beyond the 10-year scope of current established CV risk algorithms. At 20 years follow-up, CV mortality rates were 3–5 times higher compared with the first decade, indicating that 20-year CV mortality risk for both men and women cannot simply be estimated based on extrapolation of 10-year risk.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): EPIC-Norfolk is supported by programme grants from the Medical Research Council UK (MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (CRUK 8257).
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Affiliation(s)
- T Van Trier
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - H T Jorstad
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - M Snaterse
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | | | - F L J Visseren
- University Medical Center Utrecht, Department of Vascular Medicine , Utrecht , The Netherlands
| | - J A N Dorresteijn
- University Medical Center Utrecht, Department of Vascular Medicine , Utrecht , The Netherlands
| | - N J Wareham
- University of Cambridge, MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science , Cambridge , United Kingdom
| | - R Lindeboom
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics , Amsterdam , The Netherlands
| | - R J G Peters
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - S M Boekholdt
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
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Salarbaks AM, Lindeboom R, Nijmeijer W. Pneumonia in hospitalized elderly hip fracture patients: the effects on length of hospital-stay, in-hospital and thirty-day mortality and a search for potential predictors. Injury 2020; 51:1846-1850. [PMID: 32482422 DOI: 10.1016/j.injury.2020.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fracture in the elderly is associated with increased morbidity and mortality. Pneumonia during hospitalization is not uncommon and is associated with poorer outcomes, such as an increased risk of readmission and higher mortality rates. We aim to identify independent predictive factors for developing pneumonia during hospitalization in this group and also assessed the effect pneumonia has on hospital-stay, in-hospital and 30-day mortality. METHODS Retrospective cohort study with prospectively collected data from hospitalized elderly hip fracture patients between January 2015 and January 2017. Examined predictors were age, gender, pre-fracture living situation, pre-fracture mobility score, pre-fracture ADL-status, history of dementia, diabetes, congestive heart failure, chronic obstructive pulmonary disease and prior stroke, ASA-score, anemia at admission, surgery within 48 hours, surgical procedure and anesthesia used. Multivariable regression analysis including resampling methods (bootstrapping) was used to examine the effects of predictors. RESULTS Of 407 patients, 62 (15.2%) were treated for pneumonia during hospitalization. Only gender, surgery within 48 hours and history of COPD differed significantly at baseline between the groups with and without pneumonia. Adjusted for age and gender, we observed a 1.6 times longer hospital-stay (95% CI 1.4-1.9, p<0.001), higher in-hospital mortality (OR 8.0, 95% CI 2.97-22.29) and 30-day mortality (OR 3.22, 95% CI 1.44-6.94) in the pneumonia-group. Pneumonia explained 9.1% of the variance in the length of hospital-stay aside from age and gender. Eight candidate predictors from the univariate analyses with a p<0.20 were selected for a multivariable logistic regression in 1000 bootstrap samples. Gender and history of COPD were most often found to have a p<0.10 (61.3% and 58.2%, respectively) in the bootstrap analyses and more than 80% stability in their B-coefficient signs. The discriminative quality of these two variables alone resulted in an AUC of 61.7% (95% CI 54%-69%). CONCLUSION Pneumonia resulted in longer hospital-stay and higher mortality rates. Of the 15 selected potential risk-factors for developing pneumonia during admission, male gender and history of COPD appeared to have the best potential as predictors. The other risk-factors had poorer performance, probably due to the few events and limited occurrence of some candidate variables in our study population.
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Affiliation(s)
| | - R Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam
| | - W Nijmeijer
- Department of Trauma Surgery, ZGT, Netherland
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Vink P, Lucas C, Maaskant JM, van Erp WS, Lindeboom R, Vermeulen H. Clinimetric properties of the Nociception Coma Scale (-Revised): A systematic review. Eur J Pain 2017; 21:1463-1474. [PMID: 28573825 PMCID: PMC5600098 DOI: 10.1002/ejp.1063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/12/2022]
Abstract
The Nociception Coma Scale is a nociception behaviour observation tool, developed specifically for patients with disorders of consciousness (DOC) due to (acquired) brain injury. Over the years, the clinimetric properties of the NCS and its revised version (NCS‐R) have been assessed, but no formal summary of these properties has been made. Therefore, we performed a systematic review on the clinimetric properties (i.e. reliability, validity, responsiveness and interpretability) of the NCS(‐R). We systematically searched CENTRAL, CINAHL, Embase, PsycInfo and Web of Science until August 2015. Two reviewers independently selected the clinimetric studies and extracted data with a structured form. Included studies were appraised on quality with the COSMIN checklist. Eight studies were found eligible and were appraised with the COSMIN checklist. Although nearly all studies lacked sample size calculation, and were executed by the same group of authors, the methodological quality ranged from fair to excellent. Important aspects of reliability, construct validity and responsiveness have been studied in depth and with sufficient methodological quality. The overview of clinimetric properties in this study shows that the NCS and NCS‐R are both valid and useful instruments to assess nociceptive behaviour in DOC patients. The studies provide guidance for the choice in NCS‐R cut‐off value for possible pain treatment and cautions awareness of interprofessional differences in NCS‐R measurements. Significance This systematic review provides a structured overview of the clinimetric properties of the Nociception Coma Scale (‐Revised) and provides insights for a solid evidence‐based nociception behaviour assessment and treatment plan.
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Affiliation(s)
- P Vink
- Department of Neurology and Neurosurgery, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Omni Cura Nursing Teaching Research, Amsterdam, The Netherlands
| | - C Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty (AMC), University of Amsterdam, The Netherlands
| | - J M Maaskant
- Emma Children's Hospital, Academic Medical Center Amsterdam, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - W S van Erp
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands.,Coma Science Group, Cyclotron Research Center and Neurology Department, University of Liège, Belgium
| | - R Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty (AMC), University of Amsterdam, The Netherlands
| | - H Vermeulen
- Department of Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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Hoytema van Konijnenburg EMM, van der Lee JH, Teeuw AH, Lindeboom R, Brilleslijper-Kater SN, Sieswerda-Hoogendoorn T, van Goudoever JB, Lindauer RJL. Psychosocial problems of children whose parents visit the emergency department due to intimate partner violence, substance abuse or a suicide attempt. Child Care Health Dev 2017; 43:369-384. [PMID: 27774638 DOI: 10.1111/cch.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND High levels of maltreatment are found in children who are identified because their parents visit the emergency department due to partner violence, substance abuse or suicide attempt. However, it is unknown if these children experience psychosocial problems. This study aims to assess their levels of post-traumatic stress, anxiety, depression, behavioural problems and health-related quality of life. METHODS A cross-sectional study was conducted in six hospitals. All consecutive families of which a parent visited the emergency department due to partner violence, substance abuse or suicide attempt between 1 July 2012 and 1 March 2014 with children aged 1.5-17 years were approached for participation. Parents and children aged 8 years and older filled out questionnaires measuring post-traumatic stress [13-item version of Children's Revised Impact of Event Scale (CRIES-13)], anxiety, depression (Revised Child Anxiety and Depression Scale), behavioural problems [Child Behavior Checklist (CBCL) and Youth Self-Report (YSR)] and health-related quality of life (PedsQL). Scores of participants were compared with reference data obtained in children in similar age ranges from representative Dutch community samples (CRIES-13, Revised Child Anxiety and Depression Scale, PedsQL and CBCL) and to a normed cutoff score (CRIES-13). RESULTS Of 195 eligible families, 89 (46%) participated in the study. Participating children did not score different from community children, both on child-reported and parent-reported instruments. Standardized mean differences of total sum scores were 0 (CRIES-13 and CBCL 1.5-5), 0.1 (YSR), 0.2 (CBCL 6-18) and -0.3 (PedsQL) and not statistically different from community children. Thirty-five percent of the participating children scored above the cutoff score on the CRIES-13, indicating post-traumatic stress disorder, but this difference was not statistically significant from community children (mean difference 8%; 95% CI -4-22%). CONCLUSIONS We found no differences in psychosocial problems between children whose parents visited the emergency department due to partner violence, substance abuse or suicide attempt and children from community samples. Because 35% of the children scored in the range of post-traumatic stress disorder, we advise healthcare providers to pay attention to post-traumatic stress symptoms.
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Affiliation(s)
- E M M Hoytema van Konijnenburg
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J H van der Lee
- Pediatric Clinical Research Office, Woman-Child Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A H Teeuw
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S N Brilleslijper-Kater
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - T Sieswerda-Hoogendoorn
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Pediatrics, VU University Medical Center, VU University, Amsterdam, the Netherlands
| | - R J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,The Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Amsterdam, the Netherlands
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6
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van Cranenburgh O, Nijland S, Lindeboom R, de Korte J, de Rie M, ter Stege J, Prinsen C. Patients with lichen sclerosus experience moderate satisfaction with treatment and impairment of quality of life: results of a cross-sectional study. Br J Dermatol 2017; 176:1508-1515. [DOI: 10.1111/bjd.15125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 01/03/2023]
Affiliation(s)
- O.D. van Cranenburgh
- Dutch Skin Foundation; Utrecht the Netherlands
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | | | - R. Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - J. de Korte
- Dutch Skin Foundation; Utrecht the Netherlands
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - M.A. de Rie
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- VU University Medical Center; Department of Dermatology; Amsterdam the Netherlands
| | | | - C.A.C. Prinsen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- VU University Medical Center; Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; Amsterdam the Netherlands
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7
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Weel H, Lindeboom R, Kuipers SE, Vervest TMJS. Comparison between the Harris- and Oxford Hip Score to evaluate outcomes one-year after total hip arthroplasty. Acta Orthop Belg 2017; 83:98-109. [PMID: 29322902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Harris Hip Score (HHS) is a surgeon administered measurement for assessing hip function before and after total hip arthroplasties (THA). Patient reported outcome measurements (PROMs) such as the Oxford Hip Score (OHS) are increasingly used. HHS was compaired to the OHS assessing whether the HHS can be replaced by the OHS for clinical evaluation of THAs. All 155 patients (167 THAs) were asked to complete an OHS before and one-year after surgery. The surgeon independently scored the HHS at the same time points. We examined and compared the clinimetric properties of both instruments. Internal consistency reliability of the OHS was notably higher than that of the HHS at all occasions. HHS had a higher effect size (4.1) than the OHS (2.1). Ceiling effect at follow up was 55.6% (HHS) and 36.4% (OHS). Spearman's rank correlation between HHS and OHS was 0.57 at baseline and 0.65 and after one year. The correlation between the change scores was 0.50. The Oxford Hip Score is of good use in quality assessment after THA.
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Prinsen C, Spuls P, Lindeboom R, Sprangers M, de Rie M, de Korte J. The efficacy of a health-related quality-of-life intervention during 48 weeks of biologic treatment of patients with moderate to severe psoriasis: results of a multicentre randomized controlled trial. Br J Dermatol 2015; 173:1091-4. [DOI: 10.1111/bjd.13906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- C.A.C. Prinsen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Epidemiology and Biostatistics; EMGO+ Institute for Health and Care Research; VU University Medical Center; De Boelelaan 1089a 1081 HV Amsterdam the Netherlands
| | - P.I. Spuls
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - R. Lindeboom
- Division of Clinical Methods and Public Health; Master Evidence Based Practice; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - M.A.G. Sprangers
- Department of Medical Psychology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - M.A. de Rie
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Dermatology; VU University Medical Center; De Boelelaan 1117 P.O. Box 7057 1007 MB Amsterdam the Netherlands
| | - J. de Korte
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
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Sommers J, Vredeveld T, Horn J, Engelbert RH, Lindeboom R, Schaaf M. Psychometric properties of the de Morton Mobility Index in ICU patients. Crit Care 2015. [PMCID: PMC4470470 DOI: 10.1186/cc14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Kneepkens RF, Lindeboom R. Age dependent decline of relative risks in life insurance medical underwriting. J Insur Med 2014; 44:170-183. [PMID: 25622389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED INTRODUCTORY: Life insurance medicine focuses on mortality hazards. People are free to insure themselves for small or large amounts and for short or long-terms. This freedom makes it necessary for life insurers to assess and select the mortality risks in a medical underwriting process. Medical underwriting guidelines are based on company statistics, population surveys following (clinical) epidemiological principles and clinical studies. Mortality of potential life insurance applicants is compared to life tables of insured populations, or to adjusted life tables of the general population. Because many risk determinants have higher normal values at higher ages, it is reasonably to assume that the relative hazards (RHs) or mortality ratios calculated for these risk determinants should be age dependent. This is also common use in underwriting guidelines, and can have much influence on the accessibility of life insurances for (chronically) diseased people. A proof of principle is therefor warranted. METHODS This population-based cohort study uses NHANES- datafiles from the Third National Health and Nutrition Examination Survey (NHANES III) and the NHANES Linked Mortality Files 2010. Only participants aged 20 to 69 that were examined in mobile examination centers, without a history of some prevalent high risk diseases were included. The observed mortality was compared to the expected mortality in a Generalized Linear Model (GLM) with Poisson error structure with two reference populations, which theoretically both can serve as preferred reference for life insurers: The United States Life Tables 2008 and the 2008 Valuation Basic Tables based on the insured population of 35 US life insurers. The age dependency was assessed of the values and the RH s of the systolic blood Pressure (SBP), aspartate aminotranseferase (ASAT), lactate dehydrogenase (LDH), serum albumin and albuminuria, with correction for ethnicity, household income, history of diabetes mellitus, BMI and serum cholesterol. RESULTS All 5 continuous risk determinants had age dependent values in the comparison between ages 20-54 and 55-69 (Mann-Whitney U P < 0.001). Graphical inspections using age at time of interview revealed only for the SBP an increase with age. In the GLM again only SBP had a significant interaction term with age at time of interview. It made no difference which life tables were used for the calculation of the expected mortality. DISCUSSION Age dependency of RHs of risk determinants can be assumed if the risk determinants themselves are age dependent on statistical and graphical inspection. In other cases age dependency might not be significant, or cannot be modelled with some form of linear function as customary in many underwriting guidelines. The RHs or mortality ratios in current medical underwriting guidelines for life insurances should be checked for age dependency by analysing the underlying data statistically and graphically and by using GLM and appropriate life tables.
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Abstract
PURPOSE To examine the reproducibility of the institutional version of the Dutch Activity Card Sort (ACS-NL) and the possible presence of gender bias. METHODS Older rehabilitation inpatients (N = 52) were included. Intra- and inter-rater agreement for the ACS-NL total and subscale scores was examined by intraclass correlations (ICC), and agreement of individual items by the κ coefficient (k). Gender bias was examined by the proportion of men and women selecting an ACS item. RESULTS ICC for inter-rater agreement of the ACS total score ranged between 0.78 and 0.87, ICC for intra-rater agreement ranged between 0.79 and 0.89. Median inter-rater κ for ACS-NL items was 0.72 (interquartile scores; 0.62-0.80). The inter-rater agreement (k = 0.43) and intra-rater agreement (k = 0.39) for the five most important activities was lower. Twenty ACS activities favoured men and seven activities favoured women. As a result, men scored systematically higher on the ACS-NL than women. Logistic regression analysis correcting for activity engagement level confirmed our findings. CONCLUSIONS The reproducibility of the ACS-NL was high. The ACS-NL institutional version score may be biased in favour of men.
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Affiliation(s)
- A M Jong
- Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam and Slotervaart ziekenhuis, Amsterdam, Netherlands.
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12
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Schram ME, Spuls PI, Leeflang MMG, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy 2012; 67:99-106. [PMID: 21951293 DOI: 10.1111/j.1398-9995.2011.02719.x] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Demonstration of adequate reliability and validity is sufficient for concluding that an instrument is applicable for descriptive and predictive purposes, but before we can confidently use an outcome measure in clinical trials, the responsiveness (synonymous with sensitivity to change) and minimal clinically important difference (MCID) should be known. With this study, we aimed to assess responsiveness and MCID of four outcome measures used in atopic eczema: the Severity Scoring of Atopic Dermatitis (SCORAD), the objective SCORAD, Eczema Area and Severity Index (EASI), and the Patient-Oriented Eczema Measure (POEM). METHODS Data of three randomized controlled trials were used. To demonstrate responsiveness, we plotted receiver operating characteristic (ROC) curves. MCID was estimated using mean change scores of patients that showed a relevant improvement. Bland and Altman methods were used to quantify the limits of agreement. RESULTS Area under the ROC curve for the SCORAD was 0.70 [95% confidence interval (CI): 0.61-0.78], for the objective SCORAD, 0.73 (95% CI: 0.70-0.77), for the EASI, 0.67 (95% CI: 0.60-0.76), and for the POEM, 0.67 (95% CI: 0.59-0.75). Scores above 0.70 represent a fair responsiveness. The MCID was 8.7 points for the SCORAD, 8.2 for the objective SCORAD, 6.6 for the EASI, and 3.4 for the POEM. CONCLUSION The objective SCORAD and SCORAD showed a fair responsiveness. The MCIDs are an important prerequisite for the interpretation of published eczema trials and for the planning/sample size estimation of future trials.
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Affiliation(s)
- M E Schram
- Department of Dermatology, Academic Medical Center, University of Amsterdam, the Netherlands.
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13
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Brenninkmeijer EEA, Spuls PI, Lindeboom R, van der Wal AC, Bos JD, Wolkerstorfer A. Excimer laser vs. clobetasol propionate 0·05% ointment in prurigo form of atopic dermatitis: a randomized controlled trial, a pilot. Br J Dermatol 2011; 163:823-31. [PMID: 20491772 DOI: 10.1111/j.1365-2133.2010.09858.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent findings have established the 308-nm xenon chloride excimer laser (EL) as a new option in the area of ultraviolet (UV) B phototherapy. As this laser enables high radiant exposure of narrowband UVB and precise targeting of affected skin, it appears to be a promising treatment for the prurigo form of atopic dermatitis (AD). OBJECTIVES To investigate the efficacy and safety of the EL compared with clobetasol propionate (CP) in the prurigo form of AD. METHODS In a prospective randomized within-patient controlled study, 13 patients with a prurigo form of AD were randomized to receive EL on one side and topical CP on the other side. Laser treatment was performed twice a week for 10 weeks. Clinical responses were evaluated using Physician Assessment of Individual Signs, Physician Global Assessment, Patient Global Assessment and photographic documentation. Histopathological changes were evaluated and duration of remission was monitored during a 6-month follow-up period. RESULTS Both treatments resulted in a significant improvement of all outcome measures after 10 weeks of treatment. During follow up, the EL showed more improvement compared with CP. Histopathology demonstrated marked decrease of epidermal thickness and inflammatory infiltrate at the EL-treated sites. No significant side-effects occurred. CONCLUSIONS This study suggests that the EL can safely and effectively be used in the treatment of the prurigo form of AD. For the long term, the EL might be a good alternative to topical corticosteroids and an option in case of therapy-resistant patients.
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Affiliation(s)
- E E A Brenninkmeijer
- Department of Dermatology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, the Netherlands.
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14
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Suijkerbuijk AWM, van Steenbergen JE, Sonder GJB, Lindeboom R, Doorduyn Y. Response to 'too early to stop immigrant vaccination programmes'. Eur J Public Health 2010; 20:7. [DOI: 10.1093/eurpub/ckp139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Nijkrake MJ, Keus SHJ, Quist-Anholts GWL, Overeem S, De Roode MH, Lindeboom R, Mulleners W, Bloem BR, Munneke M. Evaluation of a Patient-Specific Index as an outcome measure for physiotherapy in Parkinson's disease. Eur J Phys Rehabil Med 2009; 45:507-512. [PMID: 20032909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of this paper was to develop and evaluate a patient-specific index for physiotherapy in Parkinson's disease (PSI-PD). METHODS In the PSI-PD, patients 1) select problematic activities out of a predefined list, with one self-report item; 2) rank selected items in order of importance; and 3) rate severity for each ranked item. To examine test-retest reliability, a cohort of patients was asked to complete the PSI-PD twice. Afterwards, validity was evaluated using a telephone interview. RESULTS The PSI-PD was completed twice by 81 patients. Test-retest agreement for the selection of activity limitations was 73% to 94%. Items ranked by patients were categorized into domains, of which gait, transfers and dexterity were rated most frequently (41%-70%). Test-retest agreement for ranked domains ranged from 74% to 82%. Interviews confirmed that the PSI-PD reliably identified problem areas. CONCLUSIONS The PSI-PD is a relevant, reliable and valid instrument to identify limitations in everyday activities that are important for both PD patients and physiotherapists.
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Affiliation(s)
- M J Nijkrake
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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16
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Suijkerbuijk AWM, Lindeboom R, van Steenbergen JE, Sonder GJB, Doorduyn Y. Effect of Hepatitis A vaccination programs for migrant children on the incidence of Hepatitis A in the Netherlands. Eur J Public Health 2009; 19:240-4. [DOI: 10.1093/eurpub/ckn145] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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17
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Curvers WL, Bohmer CJ, Mallant-Hent RC, Naber AH, Ponsioen CI, Ragunath K, Singh R, Wallace MB, Wolfsen HC, Song LMWK, Lindeboom R, Fockens P, Bergman JJ. Mucosal morphology in Barrett's esophagus: interobserver agreement and role of narrow band imaging. Endoscopy 2008; 40:799-805. [PMID: 18828075 DOI: 10.1055/s-2008-1077596] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS We have recently proposed a classification of mucosal morphology in Barrett's esophagus based on three criteria: regularity of mucosal pattern, regularity of vascular pattern, and presence of abnormal blood vessels. We aimed to evaluate the interobserver agreement with the proposed mucosal morphology classification and to assess the additional value of narrow band imaging (NBI) over high resolution white light endoscopy (HR-WLE). PATIENTS AND METHODS Five international experts in the field of Barrett's imaging and seven community endoscopists with no expertise in this field independently evaluated magnified still images from 50 areas, obtained with HR-WLE and NBI, in Barrett's esophagus patients. Visual analogue scales (VAS) were used for scoring imaging quality. Interobserver agreement for mucosal morphology and yield for identifying early neoplasia were assessed. RESULTS Imaging qualities of NBI were rated more highly than HR-WLE, when evaluated separately as well as in a side-by-side comparison. The interobserver agreement ranged from 0.40 to 0.56 and did not significantly differ between expert and non-expert endoscopists. The overall yield for correctly identifying images of early neoplasia was 81 % for HR-WLE, 72 % for NBI and 83 % for HR-WLE + NBI, with no significant difference between experts and non-experts. CONCLUSION Interobserver agreement for the classification of mucosal morphology was moderate. Although NBI was rated more highly than HR-WLE for imaging quality, this did not result in improved interobserver agreement or increased yield for identifying early neoplasia in Barrett's esophagus. This applied to non-expert as well as expert endoscopists.
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Affiliation(s)
- W L Curvers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
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18
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Abstract
BACKGROUND The current method for radiological measurements on plain X-rays of distal radius fractures is unreliable. We examined the reproducibility of a new X-ray assessment technique-where the uninjured side is used as a template for the injured side-compared to the conventional assessment technique. METHODS X-rays of 30 patients with a unilateral distal radial fracture were included reflecting the prevalence of AO fracture types in clinical practice. Eight experienced observers assessed these X-rays on two separated occasions (2-month interval) using the traditional measurement technique and the template technique. Reproducibility of the X-ray assessments was quantified by intraclass correlations and weighted kappa coefficients. RESULTS The reproducibility of the radial length measurement did not improve nor did the volar angulation measurement. However, marked improvement in reproducibility was observed for the radial inclination measurement, the kappa increased from 0.36 (95 % CI; 0.30-0.41) to 0.49 (95 % CI; 0.43-0.55) in the template technique. As a result, the classification of the reduction results (Lidström score) greatly improved. The overall kappa for the Lidström score improved from 0.37 (95 % CI; 0.31/0.43) to 0.59 (0.52/0.63). CONCLUSION The assessment technique using the uninjured side as a template for the injured side resulted only in an improved reproducibility of the radial inclination measurement which in turn resulted in an improved classification reproducibility of the reduction results.
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Affiliation(s)
- P V van Eerten
- Department of Surgery/Traumatology, Máxima Medical Center, PO Box 90052, 5600 PD Eindhoven, The Netherlands.
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19
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Abstract
BACKGROUND The Voice Handicap Index is a tool for measuring the psychosocial consequences of voice disorders and consists of three dimensions. Previous psychometric evaluation of the VHI focused on the classic evaluation of reliability and validity, which is sample dependent. The authors used Rasch analysis to re-examine the dimensionality of the VHI and to produce item and scale statistics that are less sample dependent. In addition, they provide estimates of VHI item and person severities that are reported on the same logit unit scale, allowing a more straightforward interpretation of a VHI test score. PATIENTS Dysphonic patients (N = 530), who were referred for phoniatric examination, filled out the VHI. RESULTS Rasch analysis revealed two truly uni-dimensional constructs: the 20-item psychosocial scale and the 9-item physical-functional scale. Logit item severity measures ranged from -2.1 to +2.7. Person severity scores ranged from -4.4 to + 4.4 logits. The internal consistency of the reduced scales was similar to that of the original total VHI (0.95 and 0.84). The VHI consisted of two uni-dimensional constructs. Raw test scores can be transformed into logit unit severity measures, making the VHI more suitable for evaluating the effectiveness of voice-related therapy.
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Affiliation(s)
- H C A Bogaardt
- Department of Phoniatrics and Otolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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20
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Slot DE, Lindeboom R, Rosema NAM, Timmerman MF, van der Weijden GA. The effect of 0.12% chlorhexidine dentifrice gel on plaque accumulation: a 3-day non-brushing model. Int J Dent Hyg 2007; 5:45-52. [PMID: 17250578 DOI: 10.1111/j.1601-5037.2007.00227.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Maintaining an adequate low level of plaque through daily tooth brushing is often not feasible. Effective chemotherapeutic agents as an adjunct to mechanical plaque control would therefore be valuable. Chlorhexidine (CHX) mouthwash has proved to be an effective inhibitor of plaque accumulation. AIM The purpose of the present study was to assess the effect of application of 0.12% CHX dentifrice gel on de novo plaque accumulation. MATERIAL AND METHODS The study was designed as a single blind, randomized three-arm parallel clinical trial. At the beginning of the test period all volunteers received a thorough professional oral prophylaxis. Subjects were randomly assigned to one of three regimens. During a 3-day non-brushing period, subjects abstained from all forms of mechanical oral hygiene. One regimen (test group) used 0.12% chlorhexidine dentifrice gel (CHX-DGel, Perio.Aid) applied in a fluoride gel tray, the benchmark control group used a regular dentifrice applied in a fluoride gel tray (RegD, Everclean HEMA). The positive control group rinsed with a 0.12% chlorhexidine mouthwash (CHX-MW, Perio.Aid). The Quigley and Hein plaque index (PI) from all subjects was assessed after 3 days of de novo plaque accumulation. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale scores. After the experimental period, habitual oral hygiene procedures were resumed. RESULTS Ninety-six systemically healthy subjects completed the study. After 3 days, the full-mouth PI for the CHX-DGel regimen was 1.87 compared with 1.93 for the RegD regimen and 1.55 for the CHX-MW regimen. The two dentifrices (CHX-DGel and RegD) were significantly less effective as the CHX-MW (P=0.0006). No significant difference between scores of the dentifrices was found. CONCLUSION Within the limitations of the present 3-day non-brushing study design, it can be concluded that application of 0.12% CHX dentifrice gel is not significantly different from application of regular dentifrice on plaque accumulation. Use of a 0.12% CHX mouthwash is significantly more effective. CHX-DGel appears a poor alternative for a dentifrice. It is not an effective inhibitor of plaque growth and does not possess fluoride.
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Affiliation(s)
- D E Slot
- School for Dental Hygiene, Inholland University of Professional Education, Amsterdam, The Netherlands.
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21
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van Grinsven S, Kesselring FOHW, van Wassenaer-van Hall HN, Lindeboom R, Lucas C, van Loon CJM. MR arthrography of traumatic anterior shoulder lesions showed modest reproducibility and accuracy when evaluated under clinical circumstances. Arch Orthop Trauma Surg 2007; 127:11-7. [PMID: 16944235 DOI: 10.1007/s00402-006-0205-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We examined the reproducibility and accuracy of high-field MRA in traumatic anterior shoulder instability under conditions resembling clinical practice and assessed the influence of observer experience. MATERIALS AND METHODS Two radiologists with different experience levels evaluated 61 MRAs. Assessment was independent, blinded and non-sequential. For 40 MRAs, surgical reports were available to assess diagnosis accuracy and influence of observer experience. The assessed lesions were cuff lesions, Hill-Sachs lesions, bony and classic Bankart lesions, greater humeral tuberosity fractures, SLAP lesions and joint capsule lesions. Reproducibility was quantified using kappa coefficients. Accuracy was evaluated with sensitivity and specificity rates, positive and negative predictive values. Differences in the percentage of correctly diagnosed MRAs between the radiologists were tested using McNemar's test for paired proportions. RESULTS Inter-observer k-values ranged from 0.03 for joint capsule lesions to 0.45 for humeral head lesions. The overall kappa was 0.21 (95% CI; 0.12-0.30). We also observed markedly lower sensitivity and specificity rates than those reported in the literature for most lesions. The more experienced radiologist correctly diagnosed 78.9% of all lesions compared to 65.4% for the less experienced radiologist (P < 0.001; McNemar's test). CONCLUSION MRA-interpretations of traumatic anterior shoulder instability should be regarded with caution in clinical practice. The experience level of radiologists can affect reproducibility and accuracy.
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Affiliation(s)
- S van Grinsven
- Department of Physiotherapy, Rijnstate Hospital, Wagnerlaan 55, 6800 TA Arnhem, The Netherlands.
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22
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Kuiken SD, Lindeboom R, Tytgat GN, Boeckxstaens GE. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2005; 22:157-64. [PMID: 16011674 DOI: 10.1111/j.1365-2036.2005.02524.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Visceral hypersensitivity is considered an important pathophysiological mechanism in irritable bowel syndrome, yet its relationship to symptoms is unclear. AIM To detect possible associations between symptoms and the presence of hypersensitivity to rectal distension in patients with irritable bowel syndrome. METHODS Ninety-two irritable bowel syndrome patients and 17 healthy volunteers underwent a rectal barostat study. The association between specific irritable bowel syndrome symptoms and the presence of hypersensitivity was examined using Area under the Receiver Operating Characteristic curves. RESULTS Irritable bowel syndrome patients had significantly lower thresholds for discomfort/pain than healthy volunteers: 24 (18-30) and 30 (27-45) mmHg above minimal distending pressure, respectively. Forty-one patients (45%) showed hypersensitivity to rectal distension. Proportions of patients with different predominant bowel habits were similar in hypersensitive and normosensitive subgroups (diarrhoea predominant: 39 and 41%, respectively; alternating type: 27 and 28%, respectively; constipation predominant: 34 and 31%, respectively). Severe abdominal pain was more frequent in hypersensitive, compared with normosensitive patients (88% vs. 67%, P = 0.02), but none of the individual irritable bowel syndrome symptoms could accurately predict the presence of hypersensitivity, as assessed by Area under the Receiver Operating Characteristic curve analysis. CONCLUSIONS Hypersensitive and normosensitive irritable bowel syndrome patients present with comparable, heterogeneous symptomatology. Therefore, selection based on clinical parameters is unlikely to discriminate individual irritable bowel syndrome patients with visceral hypersensitivity from those with normal visceral sensitivity.
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Affiliation(s)
- S D Kuiken
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
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23
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Abstract
To enhance the score interpretation and practicality of the Cambridge Cognitive Examination (CAMCOG) neuropsychological test, the authors used item response theory (IRT) to calibrate the difficulty of the items using the scores of 797 subjects. Forty-seven items fitted the IRT model. Score agreement with equally difficult short forms was excellent. The practicality and interpretability of the CAMCOG was improved, while the diagnostic accuracy of the short forms was similar to that of the original 60-item instrument.
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Affiliation(s)
- R Lindeboom
- Department of Clinical Epidemiology and Biostatistics, J2-212, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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24
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Lindeboom R, Holman R, Dijkgraaf MGW, Sprangers MAG, Buskens E, Diederiks JP, De Haan RJ. Scaling the sickness impact profile using item response theory: an exploration of linearity, adaptive use, and patient driven item weights. J Clin Epidemiol 2004; 57:66-74. [PMID: 15019012 DOI: 10.1016/s0895-4356(03)00212-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2003] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of the study was to enhance the clinical interpretation and practicality of the widely used comprehensive Sickness Impact Profile. METHOD Item Response Theory (extension of the Rasch model) was used to calibrate the severity of the SIP items, to assess item bias and to construct equally severe short forms of the SIP that can be used interchangeably. The scores of 1507 subjects were analyzed. RESULTS Of the 127 SIP items, 82 items fitted the extended Rasch model, i.e., the observed proportions of sickness level groups endorsing the items corresponded to the proportions expected by the model. The item severity hierarchy allowed a more straightforward interpretation of the calibrated SIP-82 scores. Some items showed bias in age, gender, or diagnosis groups. The equivalent short forms agreed sufficiently well with the calibrated SIP-82 item pool to be used interchangeably. We observed a moderate correlation between the original SIP item severity weights and the Rasch item severity calibrations (r=0.53). CONCLUSION The interpretability and practicality of the SIP was enhanced by the IRT calibration. Using the item calibrations, short forms can be assembled that can be used interchangeably.
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Affiliation(s)
- R Lindeboom
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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25
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Zuur CL, de Bruijn AJG, Lindeboom R, Tange RA. Retrospective Analysis of Early Postoperative Hearing Results Obtained After Stapedotomy With Implantation of a New Titanium Stapes Prosthesis. Otol Neurotol 2003; 24:863-7. [PMID: 14600464 DOI: 10.1097/00129492-200311000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the early postoperative hearing results of a new titanium stapes prosthesis (K-Piston) implanted in patients with otosclerosis. STUDY DESIGN A retrospective analysis of preoperative and early postoperative hearing thresholds. SETTING One tertiary referral and teaching hospital. PATIENTS Eighteen men and 40 women, mean age 47 years, with otosclerosis. INTERVENTION Primary stapedotomy. MAIN OUTCOME MEASURE Main outcome measures were the mean gains in bone-conduction and air-conduction pure-tone thresholds, and pure-tone averages for different frequency combinations. Success and failure of the individual cases were presented using Amsterdam Hearing Evaluation Plots. RESULTS The overall postoperative air-bone gap for the frequency combination 0.5-1-2-4 kHz was 8.4 (standard deviation: 5.2) dB. In 79% of the patients the postoperative air-bone gap was less than 10 dB. Air-conduction improved even in higher frequencies, while the Carhart effect was not seen in most cases. In three patients a deterioration of bone-conduction was observed ranging from 11 to 16 dB sound pressure level (SPL), and in four patients the gain in air-conduction was insufficient (3-29 dB SPL) to close the preoperative air-bone gap to within 20 dB. CONCLUSION The new low-weight, full-titanium stapes prosthesis with its slight rough surface and its good mechanical stability and biocompatibility can safely and successfully restore the function of the middle ear when implanted in patients with otosclerosis.
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Affiliation(s)
- C L Zuur
- Department of Otolaryngology-Head and Neck Surgery, Academical Medical Center, University of Amsterdam, The Netherlands.
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26
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Abstract
The ability to perform activities of daily living (ADL) is an important part of assessment in neurologic patients. A literature search was carried out to identify multi-item ADL scales developed for the assessment of neurologic patients, comparing item content, range, and detail of ADL scales. Of the 113 ADL scales identified, 27 (24%) were designed for use in neurology. In the basic ADL (BADL) domains (basic mobility and self-care), individual items were present in 44% to 81% of instruments. In the extended ADL (EADL) domains (e.g., outdoor mobility, housekeeping), items were present in up to 67% of the instruments identified. A typical trade-off was observed between the range, the detail (number of items), and hence the practicality of a scale. In general, scales focus on either BADL or EADL domains or, on occasion, some of both, rather than measuring the full range of functioning. There are many ADL scales in neurology, with much overlap in item content, leading to redundancy. New scales developed with the traditional methods will not solve the existing difficulties associated with range and detail, ordinal scale scores, and cross-instrument comparability. The possibilities of a modern psychometric method known as item response theory that was designed to solve these problems are discussed.
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Affiliation(s)
- R Lindeboom
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
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27
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de Haan RJ, Vermeulen M, Holman R, Lindeboom R. [Measuring the functional status of patients in clinical trials using modern clinimetric methods]. Ned Tijdschr Geneeskd 2002; 146:606-11. [PMID: 11957379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In clinical medicine numerous measurement instruments have been developed to assess the functional outcome of patients in clinical trials. The majority are questionnaires with multiple-choice items. The responses of the patients are used to calculate a sum score. However, there are some disadvantages associated with the use of sum scores. Modern clinimetric methods, based on item response theory (IRT) in combination with a calibrated item bank, can overcome these problems. When using this measurement technique, it is possible to arrange both the item difficulty and the patient's ability on a single, hierarchical linear scale. This allows the user to obtain a sufficiently detailed clinical picture using a small number of items. In addition to being efficient, this method makes it possible to present different sets of items to different groups of patients. Since all of the items are calibrated, the measurements remain comparable. The application of this innovative method of measuring is being studied in the ongoing 'Amsterdam linear disability score' (ALDS) project.
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Affiliation(s)
- R J de Haan
- Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
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28
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Brans JW, Aramideh M, Koelman JH, Lindeboom R, Speelman JD, Ongerboer de Visser BW. Electromyography in cervical dystonia: changes after botulinum and trihexyphenidyl. Neurology 1998; 51:815-9. [PMID: 9748032 DOI: 10.1212/wnl.51.3.815] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The value of physical examination in detecting involved neck muscles in cervical dystonia (CD) is uncertain and little is known about changes in electromyographic (EMG) features after botulinum toxin type A (BTA) treatment. METHODS In a double-blind, randomized study we recorded the EMG activities of 420 neck muscles in 42 patients with CD before and after treatment with BTA or trihexyphenidyl. We regarded any needle EMG activity higher than 100 microV as the gold standard for involuntary involvement of a muscle in the dystonic posture and compared this with the results of physical examination. We calculated EMG total scores by adding the scores of the individual muscles. RESULTS Physical examination had a low predictive value in the detection of involved muscles. There was a significant correlation between changes in EMG total scores and changes in clinical measurements. We observed increased EMG activity in 20% of noninjected muscles after BTA treatment and in 27% of noninjected muscles after trihexyphenidyl treatment. A switch from one most active muscle to another was seen equally in both groups and had no influence on clinical response. CONCLUSION Physical examination alone is not sufficient to detect involved muscles, and repeated, simultaneous EMG-guided application of BTA may be helpful. In addition to clinical measurements, changes in EMG activity due to treatment can be used as a physiologic measure in evaluating treatment response. Increased activity of noninjected muscles and a switch from one most active muscle to another are not related to BTA treatment, but are probably pathophysiologic phenomena of CD itself.
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Affiliation(s)
- J W Brans
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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29
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Abstract
UNLABELLED There is little agreement on which outcome measures to use to express the efficacy of treatments for cervical dystonia. We analyzed change scores on various scales of 64 new patients with cervical dystonia before and after repeated injections with botulinum toxin. METHOD The association between change in impairment (Tsui), and change in pain (TWSTRS-Pain) and functional health (TWSTRS-D, MOS-20) was expressed in percentages of variance explained. Effect sizes of the outcome measures from patients who continued botulinum treatment and dropouts were compared. Performance of outcome measures to distinguish patients who continued treatment and dropouts was analyzed with ROC curves and areas under the curve (AUC). RESULTS Impairments explained < or =7% of the score variance in functional health. There were no differences between the effect sizes of impairment and pain of patients who continued treatment and dropouts (p > 0.60). This suggests a poor reflection of the treatment efficacy by these outcome measures. Conversely, there were significant differences between the effect sizes of the functional status scales of the patients who continued treatment and the dropouts (p < or = 0.01). ROC curve analysis showed that the disability, handicap, and global disease burden scale accurately distinguished between the two groups (AUCs > 0.80). Impairments showed no discriminative accuracy (AUC = 0.46). CONCLUSION Neurologic impairments have a small impact on the functional health of cervical dystonia patients. Disability, handicap, and a global measure of disease burden were the most suitable outcome parameters to express the clinical efficacy of botulinum therapy.
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Affiliation(s)
- R Lindeboom
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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30
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Abstract
We investigated the long-term effect of botulinum toxin type A (BTA) on impairment as well as functional health in terms of disability, handicap, and quality of life in 64 patients with cervical dystonia. These patients, who first participated in a double-blind trial, were followed for another 12 months. Fifty-four patients continued treatment after 12 months of follow-up and showed improvement on all scales. Furthermore, this effectiveness appeared to increase during follow-up, which suggests a cumulative clinical effect of BTA.
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Affiliation(s)
- J W Brans
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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31
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Abstract
We reviewed 21 studies (8 blinded and 13 open) on the treatment of botulinum toxin type A for cervical dystonia, directed to the health aspects used to evaluate the patients' response to treatment (Medline search 1985-1993, English language literature). The prerequisite for comparing the treatment results was that studies had to evaluate similar aspects of disease. The ICIDH model, outlined by the World Health Organization in 1980, orders the different health outcomes into distinct classes of disease consequences. Our aim was to order the health outcomes according to the model and, thus, to study the comparability of treatment outcomes. Three differences could be identified between the objective and the subjective instruments. (a) The aspects measured by the subjective instruments varied substantially; of the 22 different subjective instruments identified in 18 studies, 8 measured impairments, 5 disability, and 9 could not be classified according to the ICIDH model. The objective instruments measured impairments. (b) All objective instruments were multiitem, whereas only 2 of 22 subjective instruments could be identified as multiitem. (c) The subjective instruments were generally poorly documented with regard to the number of items, score range, or grading. We conclude that the treatment outcomes can only be compared on the objective level of assessment and with regard to the patients with painful dystonia. The subjective instruments, particularly those focusing on disease-specific disability, deserve further research. The ICIDH model offers a useful framework for selection, improvement, and development of outcome instruments. Because the model clearly demarcates the different consequences of disease, adoption will enhance the comparability of outcomes in cervical dystonia intervention trials.
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Affiliation(s)
- R Lindeboom
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Brans JW, Lindeboom R, Snoek JW, Zwarts MJ, van Weerden TW, Brunt ER, van Hilten JJ, van der Kamp W, Prins MH, Speelman JD. Botulinum toxin versus trihexyphenidyl in cervical dystonia: a prospective, randomized, double-blind controlled trial. Neurology 1996; 46:1066-72. [PMID: 8780093 DOI: 10.1212/wnl.46.4.1066] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Botulinum toxin type A (BTA) is replacing trihexyphenidyl as the treatment of choice for idiopathic cervical dystonia (ICD), but there has never been a direct comparative study. METHODS This trial compares the effectiveness of BTA with that of trihexyphenidyl in a prospective, randomized, double-blind design. Sixty-six consecutive patients with ICD were randomized to treatment with trihexyphenidyl tablets plus placebo injection or placebo tablets plus BTA injections. Tablets were administered daily according to a fixed schedule. Dysport or saline was injected under EMG guidance at study entry and again after 8 weeks. Patients were assessed for efficacy at baseline and after 12 weeks by different clinical rating scales. RESULTS Sixty-four patients completed the study, 32 in each group. Mean dose of BTA was 292 mouse units (first session) and 262 mouse units (second session). Mean dose of trihexyphenidyl was 16.25 mg. The changes on the Disability section of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-Disability) (primary outcome), Tsui Scale, and the General Health Perception Subscale were significantly in favor of BTA. More patients treated with BTA had an improvement of at least three points on the TWSTRS-Disability (14 versus 6) and on the Tsui Scale (23 versus 12). Adverse effects were significantly less frequent in the BTA group. CONCLUSION BTA is significantly more effective in the treatment of ICD, with less adverse effects.
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Affiliation(s)
- J W Brans
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Lindeboom R, De Haan R, Aramideh M, Speelman JD. The blepharospasm disability scale: an instrument for the assessment of functional health in blepharospasm. Mov Disord 1995; 10:444-9. [PMID: 7565824 DOI: 10.1002/mds.870100407] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Assessment of the functional status in patients with blepharospasm is of major importance for clinical practice and outcome studies. The Blepharospasm Disability Scale (BDS) is specifically directed to measure the disability in these patients. The metric properties of this instrument were evaluated. Reliability, validity, and responsiveness to within-patient health changes over time of the BDS were assessed in 40 patients with essential blepharospasm treated with botulinum toxin injections. The reliability of the scale was sufficient for use on group level (Cronbach's alpha coefficient, 0.69). Evidence of discriminant validity was provided by the difference in median score on the BDS between 21 newly admitted patients and 19 patients already under treatment (p < 0.001). Convergent validity was supported by correlations between BDS and neurological impairment scores (range, Spearman correlation coefficients, 0.65-0.79). Responsiveness to health changes was demonstrated by a significant difference between median BDS scores before treatment and 2 weeks after treatment with botulinum toxin (p < 0.01). The BDS is a useful disease-specific instrument to assess disability. Completion of the questionnaire is easy and takes only a few minutes. The instrument is suitable for use in patient care, descriptive outcome studies, and should be considered in controlled clinical trials.
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Affiliation(s)
- R Lindeboom
- Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands
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